Do supplements work? an in depth look into dietary supplements. Thank you Dr. Oz.

In light of Dr. Oz’s 'recent' scolding by congress, I thought it pertinent to share my feelings on dietary supplements & weight loss alternatives (other than the old-fashioned exercise & limiting caloric intake). It’s not a pretty critique, but I feel like complete honesty is necessary to illustrate the dangers and pitfalls of dietary supplements.

We all know overweight and obesity is prevalent in the US. The CDC estimated that in 2011-2012 35% of people over 20 years of age were obese, and 68% were overweight or obese, and 18% of children and adolescents are obese too (1). These numbers may go up even over the past 2 years. Avoiding obesity decreases your risk of developing many chronic diseases such as heart disease and diabetes. (Why is this important? Check it out: http://www.eatright.org/Public/content.aspx?id=6846) Before you think this is a-YOU HAVE TO LOSE WEIGHT!!!!!- type of post, it’s not. It’s hard to lose weight. Factors such as genetics, lifestyle, environment, habits, health, and socio-economic place all lead to what you eat and how active you are. So with all of these factors leading to someone’s weight, its really easy to get overwhelmed or frustrated when trying to lose weight, and just as easy to find some supplement or “quick fix” to cure us.

We are bombarded with all of theses “quick fixes” in pill form, juice form, etc that it is easy to hope that these fixes will fix our weight problem. This is particularly difficulty when people around you-whether they be family members or friends recommend that you try xy or z because it changed their life! Do they?

Also, with so much money being poured into weight loss “quick fixes”, shouldn’t Americans be seeing more results from their 34 billion dollar investments (4)? Although this is a broad industry and many confounding variables, it indicates to me that these means of weight loss aren’t resulting in actual weight loss, as Americans are getting fatter and fatter. Sorry-but really not sorry-to say, but supplements and many weight loss programs don’t work, or at least don’t work in the long run. I guess if you want to sustain your weight loss for just a few months, feel free to do so, but more than likely, the weight will likely just creep back and you’ll end up even more frustrated. Want that? I don’t! Back to Dr. Oz… No disrespect, but this is really exciting & important as Dr. Oz has been promoting a variety of supplements that have NO scientific backing, and if they report that they do, it’s often based on really small sample sizes, which can’t be used to extrapolate to being effective or safe for the whole general population, or for you.

So….. Should I say no to supplements?

There are no government requirements for testing or review before weight loss supplements are brought to market. In addition, supplements may have drug-like effects that can interact with clients’ medications or present risks for individuals with certain medical conditions. (5)

The risks outweigh benefits for supplement use: the reported adverse events from supplement use, combined with low effectiveness makes the risks outweigh the benefits of using them(as found from a systematic review of available dietary supplements) (5).

Green tea extract for example has been caused to cause liver failure in a small population. Now this is not definitive for large populations, but if taking a supplement with no medical necessity has the possibility of causing liver failure (which can get to the point of being irreversible)- sounds like something I’d want to avoid, even without strong widespread evidence at this point.

Weight-loss supplements containing metabolic stimulants (e.g., caffeine, ephedra, synephrine) are most likely to produce adverse side effects and should be avoided (3).

There is no strong research evidence indicating that a specific supplement will produce significant weight loss (>2 kg), especially in the long term. Some foods or supplements such as green tea, fiber, and calcium supplements or dairy products may complement a healthy lifestyle to produce small weight losses or prevent weight gain over time (3).

I also ran across this John Oliver segment, which really perfectly explains the whole thing better than I can. Its 15 minutes but really an entertaining and informative look into the lack of regulation, lack of scientific backup, and money pit that the dietary supplement industry is.

So with that said, check out these reliable website on dietary supplements:

Because so many people are using dietary supplements, whether they be vitamins or a pill to lead to “rapid weight loss” or increased energy, or better brain function…. It’s important to disclose this to your physician and/or pharmacist as they can interfere with medications you’re taking or they could affect a health condition you already have.

Have you used dietary supplements to promote weight loss? Any good or bad experiences?

Let's refer back to what prompted this whole thing. This video is both hilarious and unfortunate. Is this typical? Do most people have no idea why they're following certain diets?

So.....What is gluten?

Well let’s look to the Merriam Webster dictionary for an answer: gluten is a tenacious elastic protein substance [found in] wheat [products] that gives cohesiveness (it’s elastic property) to dough. Does that sound dangerous? No. Did you gain 5 pounds just reading this? Hope not. Does knowing that gluten is just a protein change your perception?So if it's just a protein found in grains, why has it gotten such a bad rap for causing weight gain, inflammation, and bloating? Good question. This may stem from celebrity endorsements and a few books claiming that you can "lose weight, shrink unsightly bulges, and reverse a broad spectrum of health problems (1) just by eliminating wheat from your diet. This was the claim made by Dr. William Davis in his book Wheat Belly. Unfortunately, the studies he cites were conducted on small populations and/or had many flaws. Long story short, more research needs to be conducted to determine the effectiveness of a wheat-free diet in curing the aforementioned problems. See a full book review here.

In defense of gluten-free: I’ve heard countless people swear by a gluten free diet for weight loss, improved bowel health, and decreased inflammation. And that’s great, if you’ve tracked your symptoms and found that wheat causes them, by all means, avoid gluten! The concerns that I have, and that many other registered dietitians have is that:

Any sort of very restrictive diet is hard to follow. Even for those with Celiac Disease; whose intestines are destroyed by an immune reaction when they consume gluten, and suffer from significant intestinal discomfort and sickness (2); it’s still difficult to follow as many commonly eaten foods are completely restricted.

Especially when following this diet to promote weight loss, it’s important to realize that some gluten free products are made with refined grains, that are not enriched with vitamins and minerals such as iron, zinc, & B vitamins (like many gluten containing breads, cereals are), and they often contain more fat and less carbohydrates and fiber. Sound healthier?

Since gluten has textural properties, manufacturers need to add more fat or other products to create equivalent or similar textures/flavors.

But, let’s be honest. Following a gluten free diet can lead to weight loss, for a time. If you cut out pasta, bread, and bakery goods-all of which are typically made with wheat; you will likely see weight loss. But, if you love bread and pasta, completely cutting it out may do more to sabotage your weight loss goals. Think about it. Have you ever been told you couldn’t have something you like? What did you want to do/did you do? Hoard it/ binge on it? Yeah, that’s our biologic response to restrictive dieting. Remember when Hostess shut down and the US went into a Twinkie buying frenzy? I’ve never liked Twinkies, but suddenly contemplated paying over $100 for a box. Hey, we tend to want what we can’t have, even if we don’t really want it.

In defense of wheat: Researchers from Arizona State University found that: Despite the health claims for gluten-free eating, there is no published experimental evidence to support such claims for the general population. In fact, there are data to suggest that gluten itself may provide some health benefits, and that gluten avoidance may not be justified for otherwise healthy individuals (2). They also sifted through studies related to the effects of a gluten free diet, finding that:

Starches found in wheat (such as oligofructose and inulin) help create a healthy composition of gut bacteria, which may protect the gut from some cancers, cardiovascular disease, and inflammatory conditions

If you’re one of the people who often feels bloated, tired, etc.. try keeping a food journal and chronicle your symptoms along with what you’re eating. This will give you an idea of what is causing your discomfort, whether it’s from a certain food or emotion such as stress. While following a gluten free diet, make sure to continue to eat gluten free whole grains, and consider seeing a registered dietitian who can help you ensure you’re getting all the vitamins and minerals needed! Find a Registered Dietitian here. So….What’s the take home message?

Focus on eating whole grain products (they have more B vitamins, fiber, and a bit more protein & also help protect your gut!), limit added sugars in grain products, and if you like it-EAT IT in moderation!

Jumping off of Melanie's fruit & vegetable topic last week, I'd like to talk about a current nutritional fad.....Juicing.When I refer to "juicing" I'm really referring to juice fasting or cleansing, that is limiting the diet to only the juice extracted from fresh fruit and vegetables for a certain amount of time. I don't remember when juicing became so popular, but it may have happened after the 2010 film Fat, Sick & Nearly Dead hailed 60-day juice fasts as the pathway to health (1). Which, unfortunately, I have not watched.Cold-pressed juices seem to be all the rage. So what is the cold-pressing process?Fruits and vegetables are fed into a tube that leads to an auger (which grinds & chews the produce to a paste) this paste is then forced through the remainder of the shaft, allegedly extracting more juice per piece of produce than the traditional centrifugal juicer. Proponents of this movement claim the slower process, lack of oxygen, and lack of heat (which is generated by the motor & spinning blades in a centrifugal unit) leaves more nutrients in the juice. At this time, there is no clinical research to show increased nutrient composition of cold pressed juices vs traditionally juiced juices (2). More than the concern about bioavailablilty of the nutrients, if you're drinking these juices sans pulp, you're missing out on the vital nutrients in the skins (particularly fiber) that you'd find in whole fruits/vegetables. Unfortunately, despite the popularity of this diet, there is very limited clinical information on juice cleanses, and the information available seems to be from studies with too-small sample sizes, and are not long enough to show any long term consequences of this diet (whether positive or negative). Along with the limited clinical studies, there is also limited information to suggest the efficacy of the process of cold pressing fruit/vegetables to enhance or maintain bioavailability of nutrients (1). Although, for someone who dislikes fruits or vegetables, and therefore isn't getting the recommended 5-a-day fruits/vegetables, juicing is certainly better than not consuming adequate amounts of fruits and vegetables.But isn't it always better to get more fruits and vegetables in your diet? Are there dangers to this diet?Up to now, there haven't been any reports of juicing-induced damage, until the reporting of a case of oxalate nepropathy (oxalate induced acute kidney failure) due to 6 weeks juicing fast as reported in the American Journal of Medicine.Although this case study focuses on a patient with the pre-existing condition of stage 3 chronic kidney disease (almost to the point of needing dialysis to filter his blood), the risk for possible kidney damage is increased by consuming high amounts of oxalate containing fruits and vegetables (such as beets, collard greens, kiwi, parsley, spinach, and soy products). If you are eating from all 5 food groups, consuming adequate dairy will decrease risk of accumulating oxalates in the blood (as calcium binds them and prevents their absorption!) Therefore, high oxalate diet without adequate calcium can increase risk of kidney disorders and other pathophysiological issues (3).

Take home message:Overall, increasing your fruit and vegetable consumption is always great! I would always recommend whole fruits over juice, but if eating whole fruits/vegetables isn't logical for you, juicing is better than nothing! When it comes to the "juice fasting" concept, in my clinical experience it would likely not cause any significant damage if followed for a few days a couple times per year. You just may not have the energy or brain power to work or exercise, and a juice diet would likely be deficient in required calories for body function, protein for muscle building, and vitamin B12, which keeps your blood cells healthy. I personally drink juice (no matter it being from fruits or vegetables) as a treat or to occasionally be part of my 5-a-day (because I really do like fruits and vegetables) instead of relying on it to lose weight or to "reset" my metabolism or body. All foods/drinks can fit into a healthy diet, its just about moderation....~Rebecca